Nursing Scholarship
Application 2015
Deadline:
Anne Arundel Medical Center Foundation
Nursing Scholarship Overview
Academic Year 2014-2015
Dear Applicant,
Thank you for your interest in applying for the Anne Arundel Medical Center (AAMC) Foundation Nursing Scholarship Program. The Nursing Scholarship Program was established in 1990 as a memorial to Marlene Reiter, RN, a staff nurse at AAMC. Since then, funds have been donated by family, friends and community organizations to continue support of this valued program. The scholarship fund is designed to encourage and support AAMC employees who are currently enrolled in undergraduate and graduate nursing programs. Recipients are selected based upon several criteria including academic achievement, letters of recommendation, community involvement, and financial need.
To be eligible for a scholarship award, applicants must: a) work at AAMC for at least 6 months; b) be in good standing without: disciplinary actions, written or above (i.e. poor attendance, or substandard work appraisals, etc.); and c) be currently enrolled in an accredited undergraduate or graduate nursing program or provide documentation of college acceptance and nursing program study plan. This year, eighteen $5,000 scholarships will
be awarded. Selected recipients must attend the Nursing Dinner on Thursday, May 7, 2015 to receive their scholarship
award. All scholarship recipients are expected to continue their employment at AAMC for one year following completion of their nursing degree. This agreement is concurrent with the Tuition Assistance policy (HR 8.6.02) and Professional Certification Program (HR 8.6.03). Recipients will be awarded the scholarship amount in increments ($2,000 at the dinner, $1,500 at six months and 12 months). Recipients who leave AAMC before the one-year commitment will be asked to repay the full or partial amount of the scholarship award to the AAMC Foundation. In order to be considered for a Nursing Scholarship Award, applicants must provide the following documentation:
Nursing Scholarship Application (signed by applicant) Career Goals Statement/Essay
One or two paragraphs expressing financial need
Copy of acceptance into an accredited undergraduate or graduate nursing program and nursing study plan (applicants taking pre-requisites will not be considered without an acceptance letter)
Copy of nursing certification in area of specialty practice (if certified) Official college transcripts
Recommendation forms (three forms required: one from Faculty/Educator; one from Clinical Director at AAMC; and one from Peer/Co-Worker)
This year greater emphasis will be placed on financial need. All applications will be scored on the following criteria: • Length of employment at AAMC
• Current work status at AAMC (i.e. full time, part time, CPT, etc.) • Career goals (written essay)
• Academic achievement (GPA)
• Community involvement (i.e. volunteer in shelters, fundraising, etc.) • Recommendation forms (peers, educator, and director)
• Financial need (written essay and disclosure of current financial assistance)
Nursing Scholarship applications must be received no later than 4 pm, on Friday, February 13, 2015. Please note
that past scholarship recipients may only apply for a Nursing Scholarship once per degree program and cannot win two consecutive years. Incomplete applications will not be considered. Complete scholarship applications should be hand delivered to:
Anne Arundel Medical Center
Clinical Education & Professional Development Department Attention: Gena Kosmides, BSN, RN
2002 Medical Parkway, Suite 255 Annapolis, MD 21401
Thank you again for your interest in the Nursing Scholarship Program. Please contact me at ext. 1541 or e-mail:
[email protected] if you have any questions. Sincerely,
Gena Kosmides
Chair, Nursing Scholarship Committee Department of Clinical Education
Anne Arundel Medical Center Foundation
Nursing Scholarship Application
Application Deadline: Friday, February 13, 2015
Personal Profile:
Name: _________________________________________ Employee ID No: _______________________ Home Address (include Zipcode): ________________________________________________________
E-mail: ______________________________________________
Phone number: ____________________________ (home) ___________________________ (work) Department: ____________________________ Supervisor: ___________________________ Current Position/Title: __________________________________________
Employment Information:
1. How long have you worked at Anne Arundel Medical Center?
Employment Dates (month/year) From: _____________ To: ______________ 2. Current Employment Status (check one):
__________ Regular Full-Time __________ Regular Part-Time __________ Other, e.g. float pool, registry, etc. (please specify) _________________________
3. How many years of experience do you have in your current role (as a Registered Nurse, PCT II, etc)? _______________________________
4. Are you currently certified in your area of specialty practice? If yes, attach copy to application. Yes __________ No __________ Does not apply ___________
5. Have you received a nursing scholarship from the AAMC Foundation in the past? Yes___________ No___________ If yes, what year? _____________
Academic Information:
1. Name of College/University: ________________________________________________________ School Address: ______________________________________________________________
2. What type of nursing degree are you currently pursuing, e.g. AA degree, BSN, Master’s degree:
_____________________________________________________________________________ If enrolled in a graduate nursing degree program, indicate area of specialization, e.g. Nursing Education, Nursing Informatics, CNS, etc:
3. When did you begin your current program (month/year)? _______________ 4. What is your anticipated graduation date (month/year)? ______________
Class Schedule:
List all of the courses that you are currently enrolled in and/or planning to take this year (January 1, 2015
to December 31, 2015)
Semester
Course Title/Number
Credits
Cost per Credit
Financial Aid Information:
1. Are you currently receiving any type of financial aid to help pay for your school costs? Yes _________No_________
If yes, please explain what type(s) of financial assistance you are receiving, e.g. Pell Grant; Perkins Loan; Traineeship; other scholarships, etc. and the amount given to you.
2. Are you receiving AAMC Tuition Assistance from the Human Resources Department? Yes _________No_________ Plan to apply in the future __________ 3. Are you enrolled in the Project Advance Grant Program at AAMC?
Yes _________No_________ Plan to apply in the future __________
Definition of community/volunteer involvement – Performs community service voluntarily without monetary compensation. Service may include but is not limited to: fundraising, missionary work, school volunteer, charitable contributions- time and/or money, etc.
1. List the volunteer activities outside of your family that you have been involved in over the past year. The number of hours spent per week with each activity must be included.
2. Describe one nursing experience in the community that has been meaningful to you.
3. How has this experience influenced your career goals?
4. Why do you think it is important to be involved in the community?
___________________________________________________________________________________ By signing this Nursing Scholarship Application, I certify that the information given on this application form is true and complete to the best of my knowledge. I also understand that applications containing incomplete or falsified
information will not be considered for review by the Nursing Scholarship Committee. If I am selected as an award recipient, I agree to work at AAMC for a period of one year following my graduation date – this time commitment to run concurrently with the Department of Human Resources and Project Advance
Grant Program work commitments, when applicable.
Anne Arundel Medical Center Foundation
Career Goals Statement
Academic Year 2015
Please use this form or a separate sheet to tell the Nursing Scholarship Committee about
yourself, your short-term and long-term career goals, and your plans for achieving your
goals. Minimum: 150 words.
Anne Arundel Medical Center Foundation
One – Two Paragraphs Expressing Financial Need
Academic Year 2015
Please use this form or a separate sheet to tell the Nursing Scholarship Committee about your
financial situation and how you would use the funds received through the scholarship award.
Anne Arundel Medical Center Foundation
Nursing Scholarship Application 2015
FACULTY/EDUCATOR RECOMMENDATION FORM
Name of Applicant (please print):
___________________________________________________
Name of Evaluator: __________________________________________________
Evaluator’s Position: ____________________________________________
Organization: ___________________________________________
To Whom It May Concern:
The above individual has applied for a nursing scholarship from the Anne Arundel Medical Center
Foundation.
You have been selected by the applicant to complete a recommendation form (attached). The
scholarship application packet, including recommendation forms, must be submitted no later than
February 13, 2015
. Incomplete application packets will not be considered by the Nursing
Scholarship Committee.
The completed Recommendation Form should be returned to:
Anne Arundel Medical Center
Clinical Education & Professional Development Department
Attention: Gena Komides, BSN, RN
2002 Medical Parkway, Suite 255
Annapolis, MD 21401
Please feel free to contact me at 443-481-1541 or
[email protected]
if you have any
questions.
Sincerely,
Gena Kosmides,
Anne Arundel Medical Center Foundation
Nursing Scholarship Application 2015
FACULTY/EDUCATOR RECOMMENDATION FORM
Please rate the applicant (print name) __________________________________ on the following
questions using the scale below:
Consistently = 4 Frequently = 3 Occasionally = 2 Seldom = 1
A. The applicant demonstrates professionalism.
1 2 3 4
B. The applicant demonstrates leadership skills in the clinical setting.
1 2 3 4
C. The applicant is a motivated learner.
1 2 3 4
D. The applicant is confident in his/her abilities.
1 2 3 4
E. The applicant is a team player and well respected by his/her peers.
1 2 3 4
F. The individual embodies the nursing qualities of dedication, compassion, and trust.
1 2 3 4
Please feel free to add any comments about the applicant (may attach extra sheet if necessary):
Evaluator’s Signature: ____________________________________
Date: _______________
Anne Arundel Medical Center Foundation
Nursing Scholarship Application 2015
PEER/CO-WORKER RECOMMENDATION FORM
Name of Applicant (please print):
__________________________________________________
Name of Evaluator: ____________________________________________________
Evaluator’s position: ________________________________________
Department: ___________________________________
To Whom It May Concern:
The above individual has applied for a nursing scholarship from the Anne Arundel Medical Center
Foundation.
You have been selected by the applicant to complete a recommendation form (attached). The
scholarship application packet, including recommendation forms, must be submitted no later than
February 13, 2015
. Incomplete application packets will not be considered by the Nursing
Scholarship Committee.
The completed Recommendation Form should be returned to:
Anne Arundel Medical Center
Clinical Education & Professional Development Department
Attention: Gena Kosmides, BSN, RN
2002 Medical Parkway, Suite 255
Annapolis, MD 21401
Please feel free to contact me at 443-481-1541 or by email at
[email protected]
if you have any
questions.
Sincerely,
Gena Kosmides,
Anne Arundel Medical Center Foundation
Nursing Scholarship Application 2015
PEER/CO-WORKER RECOMMENDATION FORM
Please rate the applicant (print name) ___________________________________ on the following
questions using the scale below:
Consistently = 4 Frequently = 3 Occasionally = 2 Seldom = 1
A. The applicant demonstrates professionalism in the workplace.
1 2 3 4
B. The applicant is committed to the organization.
1 2 3 4
C. The applicant displays leadership qualities.
1 2 3 4
D. The applicant participates in committee meetings and unit activities.
1 2 3 4
E. The applicant is a team player and well respected by his/her peers.
1 2 3 4
F. The individual embodies the nursing qualities of dedication, compassion, and trust.
1 2 3 4
Please feel free to add any additional comments about the applicant (may attach extra sheet if
necessary):
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________
Anne Arundel Medical Center Foundation
Nursing Scholarship Application 2015
CLINICAL DIRECTOR RECOMMENDATION FORM
Name of Applicant (please print): ________________________________________________________
Name of Evaluator: ________________________________________
Evaluator’s Position: ___________________________________
Department: _____________________________________
To Whom It May Concern:
The above individual has applied for a nursing scholarship from the Anne Arundel Medical Center
Foundation.
You have been selected by the applicant to complete a recommendation form (attached). The
scholarship application packet, including recommendation forms, must be submitted no later than
February 13, 2015
. Incomplete application packets will not be considered by the Nursing
Scholarship Committee.
The completed Recommendation Form should be returned to:
Anne Arundel Medical Center
Clinical Education & Professional Development Department
Attention: Gena Kosmides, BSN, RN
2002 Medical Parkway, Suite 255
Annapolis, MD 21401
Please feel free to contact me at 443-481-1541 by email at
[email protected]
if you have any
questions.
Sincerely,
Gena Kosmides,
Anne Arundel Medical Center Foundation
Nursing Scholarship Application 2015
CLINICAL DIRECTOR RECOMMENDATION FORM
Please rate the applicant (print name) __________________________________ on the following questions using the scale below:
Consistently = 4 Frequently = 3 Occasionally = 2 Seldom = 1 A. The applicant demonstrates professionalism in the workplace:
1 2 3 4
B. The applicant is committed to the organization: 1 2 3 4
C. The applicant displays leadership qualities: 1 2 3 4
D. The applicant participates in committee meetings and unit activities: 1 2 3 4
E. The applicant is a team player and well respected by his/her peers: 1 2 3 4
F. The individual embodies the nursing qualities of dedication, compassion, and trust. 1 2 3 4
Please verify applicant’s current FTE __________________________________
Please verify that the employee is in good standing (no written or above disciplinary actions, poor time and attendance, or substandard work appraisals, etc.)
Employee is in good standing: Yes No
Any further comments you wish to include about the applicant (may attach extra sheet if necessary): _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________
